Organization
GLEN ELLYN OPHTHALMOLOGY ASSOCIATES, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY A SULLIVAN (PRACTICE MANAGER)
(630) 858-4660
Entity
Organization
Contact information
Practice address
45 S PARK BLVD, SUITE 375, GLEN ELLYN, IL 60137-6280
(630) 858-4660
(630) 858-9511
Mailing address
45 S PARK BLVD, SUITE 375, GLEN ELLYN, IL 60137-6280
(630) 858-4660
(630) 858-9511
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB0740
RAILROAD MEDICARE
IL
Enumeration date
03/26/2007
Last updated
01/23/2015
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